Infants and pre-school children

Nutritional needs of infants

Breastfeeding

The World Health Organization recommends that, where possible, new parents breastfeed their babies exclusively for the first six months of life before introducing solid foods alongside (up to two years of age or older). Breast milk is a source of nutrition for babies and contains antibodies that help protect against certain infections.

The NHS outlines the benefits of breastfeeding babies. These include:

• reduced risk of certain infections;
• reduced risk of diarrhoea and vomiting;
• reduced risk of SIDS (sudden infant death syndrome);
• building a strong bond between the parent and baby.

After giving birth, for the first few days, the breasts will produce a yellow, thick, and sticky substance known as colostrum. This first milk is low in fat and rich in carbohydrates, protein, and antibodies, which makes it ideal for newborns. The milk also has a laxative effect, helping babies pass their first stools, which assists in flushing out excess bilirubin and helps prevent jaundice.

Soon after giving birth, the colostrum will begin to change into thinner, whiter milk, with mature breast milk usually starting to come through on or around the third or fourth day after birth.

Should I avoid certain foods while breastfeeding? 

There is no medical advice recommending that certain foods be avoided during breastfeeding. However, what you consume can pass through to your breast milk, so you may find that your baby is less likely to suckle if they are more sensitive to particular foods. For example, some mothers believe that strong foods such as garlic and acidic citrus fruits upset their babies. If you do have a hunch that this may be the case, then contact your GP before eliminating any specific foods to ensure that you are not inadvertently omitting any important vitamins or minerals.

Unless you have a specific allergy (to nuts, for example), there is no suggestion that these foods should be avoided either. If you suspect your baby might have an allergy or intolerance, speak to your GP. 

While there is no advice to avoid specific foods, there are recommendations to consume some foods and drinks in moderation. 

• Caffeine – this is found in tea, coffee, chocolate, and some energy and soft drinks. Caffeine is a stimulant, so it can make your baby restless. Where possible, try to limit your caffeine intake. The NHS recommends 300mg or less if you are breastfeeding. If your baby is sensitive to certain foods, your health visitor or GP may advise avoiding them. 
• Alcohol – the safest option is not to drink alcohol while breastfeeding. If you choose to drink occasionally, the NHS advises waiting two to three hours per alcoholic drink before breastfeeding, where possible. Avoid sharing a bed or sofa with your baby if you've been drinking alcohol.
• Fish – when breastfeeding, limit your consumption of mercury-containing fish (like shark) and don’t eat more than two portions of oily fish per week. 

Bottle feeding

Whether you breastfeed, bottle feed, or use a combination of both, feeding your baby can be an opportunity to bond and build a close connection.

If you would like to give your child breast milk but feel uncomfortable breastfeeding, you can also consider bottle-feeding your baby expressed milk. Expressing is a way of taking milk from the breast without the baby suckling, and can be done by hand or with a manual or electric pump.

You may also choose to feed your baby formula milk, either exclusively or alongside breast milk. First infant formula is suitable from birth, and is generally the only formula your baby needs during their first 12 months. 

There is no need to switch to follow-on formula or 'hungry baby' formula as your baby grows. Specialist formulas, including soya-based formula, should only be used following advice from a healthcare professional. If you're unsure which formula is suitable for your baby, speak to your midwife, health visitor or GP.

It can be difficult to gauge how much milk your baby needs as this can vary depending on their age, growth, and individual needs. Don't be too concerned if your baby does not stick to a particular feeding pattern. Following your baby's feeding cues can help you recognise when they're full or hungry, and your health visitor can advise you if you have any concerns about their feeding or growth. 

Though every baby is different, babies generally feed little and often. Try to follow your baby's cues rather than encouraging them to finish a bottle, as this can lead to overfeeding.

Bottle-feeding tips

• Ensure you have the right equipment before your baby is born – it’s recommended to buy a few bottles so you can use and wash them interchangeably. Also, make sure you have sterilising equipment to help you keep your baby's bottles clean. It's important to clean and sterilise all feeding equipment, including bottles and teats, before each use until your baby is at least 12 months old, to help protect them from infections.
• Follow their lead – when bottle-feeding, pay attention to what your baby is doing. If they begin to squirm, pause the feed, as they may need a break, have wind or be full.
• Follow instructions – don't rush or guess formula amounts. Ensure the water-to-formula ratio is correct to keep the feed safe for your baby. When preparing powdered formula, use freshly boiled drinking water that has cooled for no more than 30 minutes, so it's still at least 70°C when you add the powder. Always follow the manufacturer's instructions.
• Keep some ready-to-feed formula as a backup – formula can also be bought ready-made in cartons, which are great for when you are either on a trip or rushing out the door and don't have time to make up a bottle.
• Make bottles when needed – it may sound more time-consuming than making up multiple bottles in the morning and putting them in the fridge, but it is recommended that you make a fresh bottle when it is needed and that you throw away any leftover milk.
• Temperature preference – some babies prefer warm milk and others will drink it at room temperature, so try to pay attention to your baby's preference. Always check the temperature of the milk to ensure it is not too hot by placing a few drops on the inside of your wrist. The milk should feel warm or cool, not hot.

Things to look out for when breastfeeding or bottle-feeding

Diarrhoea and vomiting – it is normal for babies to regurgitate small amounts of milk at the end of their feed, but repeated vomiting or diarrhoea may be a sign that something is wrong. Babies can become dehydrated quickly, so look out for signs such as fewer wet nappies, a dry mouth or unusual drowsiness. Continue breastfeeding or offering formula as usual, using smaller, more frequent feeds if needed. Do not dilute formula milk.

If you're concerned about dehydration, contact your GP or NHS 111 for advice. Seek urgent medical help if your baby vomits blood, has green vomit or is difficult to wake. Wash your hands regularly with soap and water to help prevent infections spreading.

Poor weight gain – your midwife or health visitor will usually monitor weight gain (though you should keep an eye out yourself), and they will advise you if your baby's growth rate is a concern. Many factors may contribute to poor weight gain, from feeding difficulties to underlying health conditions. If there is a problem, your midwife, health visitor, or doctor will offer advice and support to help your baby grow and develop. 

Excessive weight gain – babies grow at different rates, and their weight can be influenced by several factors. When bottle-feeding, try to follow your baby's feeding cues and avoid encouraging them to finish a bottle if they seem full. If you are concerned that your baby is gaining weight excessively, contact your health visitor.

Introducing solid foods: complementary feeding 

When your baby reaches six months, it is recommended to begin introducing solid food in addition to breastfeeding or formula milk. At this stage, babies should be able to sit up, turn their heads and make chewing motions.

When introducing a new food, do so gradually and in small amounts, giving the digestive system time to adjust.

Try beginning with soft and mashed foods such as mashed banana, cooked vegetables or soft fruits. You can also offer suitable finger foods that your baby can hold and explore. Foods that may cause allergic reactions, such as eggs, peanuts and dairy, should be introduced one at a time and in small amounts so you can identify any reaction. If your baby doesn't take to a particular food at first, don't worry. You can try offering it again another day.

It is worth noting that a hungry baby may be less receptive to trying new foods, so try not to wait until they are too hungry or tired. Offer solids before their usual milk feed. Start with very small quantities and gradually increase them as your baby becomes more comfortable with solid foods (one to two teaspoons at first).

Babies spitting out their food and pulling faces is not necessarily an indicator of dislike and is more a way of showing they are experiencing a new sensation and taste. If they refuse a certain food, it may take a few more attempts before they decide if they like it or not.

At around nine months, your baby may be able to start picking up small pieces of food to feed themselves with. Alongside your normal feeding regime, try giving them little chopped-up pieces of soft foods such as banana or well-cooked pasta. Make sure finger foods are soft, appropriately sized and prepared safely to reduce the risk of choking. Always supervise your baby while they're eating.

Teething

Teething is the term used to describe the process of milk teeth breaking through the gums, usually beginning at around six to nine months. Though every child will differ, it can take up to two and a half years for a full set of teeth to come through and, during this time, a child may experience a variety of side effects that tend to cause discomfort and probably a few tears. 

Symptoms of teething include:

• sore, red gums 
• a mild temperature below 38°C
• a mild rash around the mouth or chin caused by dribbling
• dribbling more than usual 
• difficulty sleeping 
• chewing on objects.

A temperature of 38°C or above, diarrhoea or other signs of illness should not automatically be attributed to teething. If you're concerned, speak to your GP or contact NHS 111.

To reduce irritation, try gently rubbing your baby's gums with a clean finger or offering a chilled teething ring. You could also consider offering suitable foods to chew if your baby has started eating solids.

Nutritional needs of toddlers and pre-school children

When children are between the ages of one and five, good nutrition is essential for developing strong bones, teeth, muscles and a generally healthy body.

From around six months, babies can gradually begin eating suitable family foods as they are introduced to solids. By the age of one, children will usually be eating a variety of foods and can enjoy many of the same meals as the rest of the family, with appropriate adjustments for their age. You may still need to cut food into suitable sizes, help with feeding and supervise mealtimes. 

Young children are often full of energy, and so their need for nutrients is high. Try to incorporate a wide range of healthy foods into their diet, including fresh fruit and vegetables, starchy foods like potatoes, bread and rice, dairy, poultry, lean meats, fish, eggs and whole grains. Foods higher in salt, sugar and saturated fat can also be enjoyed as part of a varied diet, but are best offered less often and in smaller amounts.

Healthy eating for children

Try to make sure that your child is having the following every day to ensure they are receiving all of the essential nutrients needed for optimum growth and health.

Carbohydrates – carbohydrates such as cereal, bread, rice and pasta are a good source of energy for active and growing children.

Fruit and vegetables – the government recommends that everyone, including children, aim for five portions of fruit or veg per day. Children's portion sizes are smaller than adults' and should be appropriate for their age and appetite. However, this can be difficult to achieve if your child is a picky eater. Try adding fruit to puddings and smoothies, or making them into soups or sauces.

Milk and dairy foods – children need calcium in their diet for bone growth, so you should try to incorporate some into your child’s diet. From the age of one, you no longer need to use formula milk, and you can start to incorporate whole cow's milk. If your child isn't particularly keen on drinking lots of milk, you can add dairy in many other ways such as in yoghurts, sauces and cereals.

Protein – as an essential part of a child’s diet, protein is important for cell growth and survival, among other things. Some form of meat, fish or other protein sources should be eaten once or twice a day. Many nutritionists recommend two servings of fish per week, one of which should be oily, and any meat cooked should be tender to ensure chewing is not a problem. Good alternatives to meat and fish are eggs and pulses.

Fats – young children, and especially those under the age of two, require concentrated energy that is provided by fat. As children get older, they can have less fat in their diets, but healthy unsaturated fats remain important. These can be sourced from foods like oily fish, avocados, seeds and nuts. Saturated fats that are found in cream, cheese and fatty meats, on the other hand, should be limited.

Key vitamins and minerals 

Vitamin supplements – the NHS recommends vitamin D supplements for breastfed babies from birth. Children aged six months to five years are also generally recommended supplements containing vitamins A, C and D, although babies drinking 500ml or more of infant formula a day do not usually need additional vitamin supplements. Speak to your health visitor or pharmacist if you're unsure what your child needs.

Vitamin A – supports the body’s immune system and promotes healthy skin and cell development. Vitamin A can be found in eggs, cheese and some vegetables.

Vitamin C – this helps the body absorb iron and helps keep cells healthy, as well as aiding wound healing. This vitamin can be found in citrus fruits and various vegetables.

Calcium – this nutrient is necessary for the healthy development of strong bones and teeth. Calcium is commonly found in dairy products.

Iron – plays a role in many essential bodily processes, including making red blood cells that carry oxygen in the blood. Iron can be found in meat, some green vegetables, beans, lentils, and fortified breakfast cereals.

Zinc – is needed to help the body's hormones and enzymes perform. It also supports the body’s immune system and is important for repairing damaged tissue. Zinc can be found in meat, fish, dairy, whole grains and nuts.

Fussy eating

Though it can be very challenging (and sometimes worrying if you feel your child is not eating enough), it is very common for young children to refuse food. 

Fussy eating is rarely a cause for concern, as toddlers are still able to consume the right amount of nutrients to support their growth and development, even if their diet might seem limited. As long as they are eating some foods from the main food groups (veggies, starchy foods, proteins and dairy), they’re active, gaining weight and are well in themselves, you don’t need to worry. 

Children’s tastes are constantly changing. While it may seem disheartening if your child appears to have ‘gone off’ a certain food, keep offering it, as they may love it again later. You can gradually introduce other foods to see if your child likes something new; remember, it’s not uncommon for children to refuse foods they’ve never eaten before, so don’t be discouraged if this is the case. If this happens, stay calm and don't try to force-feed. Simply remove the food and try again in a few days.

Tips for managing fussy eating 

While fussy eating cannot be avoided, there are some tips for helping parents and caregivers to manage their child’s eating habits:

• Have a routine – having a consistent breakfast, lunch and dinner routine with a healthy morning and afternoon snack can help the child feel more secure. 
• Make the most of mealtimes – the best way for children to learn to eat food is by copying you, so try to sit down with them as much as possible. Eating as a family can make mealtimes more enjoyable. Sharing foods with each other and offering gentle guidance and praise can boost your child’s confidence in eating. 
• Offer encouragement – if your child tries a new food, praise them. Avoid using food as a reward or pressuring your child to eat. Instead, focus on making mealtimes relaxed and positive.
• Give them simple, healthy foods – young children are unlikely to know what they want to eat when asked, so present their foods to them simply and in small portions. 
• Try different types of foods – you might find that your child doesn’t like cooked carrots, for example, so you could try offering them grated raw carrot, instead. Similarly, if you discover your child likes potatoes, try feeding them mashed, baked or roasted potatoes, too. 
• Be patient – children are often slow eaters, so try to be patient with them. If they don’t eat everything or refuse food, try to remain calm, as children can easily pick up on when their parents are feeling stressed. This will make the whole experience much more positive for both you and your child. 

Finding a professional 

Maintaining a healthy diet for your infant or toddler can seem overwhelming, but it’s important to remember that there is support available if you’re struggling. Whether you’re having trouble breastfeeding, want to know more about specific nutrients for your child’s needs, or you’re finding it hard to cope with your child’s fussy eating, contact a health professional or a nutritionist for further guidance. 

At Nutritionist Resource, our members hold membership with a professional body, meaning they are qualified to offer nutritional advice. To find a professional near you or online, use the links below. 

Related topics

• Life stages
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